Analysis of the factors affecting outcome after combat-related cranial defect reconstruction.

Introduction: Reports on the outcomes of cranioplasty after combat-related injuries are relatively rare in the current literature. We present our results on the reconstruction of cranial defects resulting from injuries sustained in combat, comparing outcomes using autologous (iliac bone) grafts or (acrylate) allografts, and analysis of other factors that may influence the final outcome.

Material And Methods: The study comprised 207 patients with cranial defects resulting from combat-related injuries, repaired with autografts or allografts.

Subdural tuberculous abscess of the lumbar spine in a patient with chronic low back pain.

Introduction: Despite modern imaging methods, tuberculous abscess in the subdural space of the spine can lead to misdiagnosis and to neurogical complications development, even more up to paraplegia. We presented an extremely rare case of subdural tuberculous abscess of the lumbar (L) spine and paraparesis in imunocompetent a 49-year-old patient.

Case Report: A patient with chronic L syndrome and a history of intervertebral (IV) disc L3 and L5 operations got severe back pain late in July 2007.

Epidemiology of nosocomial colonization/infection caused by Acinetobacter spp. in patients of six surgical clinics in war and peacetime.

Background/aim: Acinetobacter spp. has emerged as nosocomial pathogen during the past few decades in hospitals all over the world, but it has increasingly been implicated as a serious nosocomial pathogen in military hospitals. The aim of this study was to analyse and compare the surveillance data on Acinetobacter nosocomial colonization/infection (NCI) collected during the wartime with the data collected in peacetime.

Peripheral nerve lesions associated with missile-induced pseudoaneurysms.

Object: Reports of traumatic pseudoaneurysms associated with nerve compression are rare, and typically do not focus on the damaged nerves. This prospective study examines the clinical presentation, management, and treatment outcome of such nerve injuries.

Methods: Between 1991 and 1995, 22 patients with a missile-induced nerve injury associated with a pseudoaneurysm were treated surgically at the Belgrade Military Medical Academy.

Radial nerve repair using an autologous denatured muscle graft: comparison with outcomes of nerve graft repair.

Background: The efficiency of denatured muscle grafting in nerve repair has been confirmed in experimental models and animals. The first clinical trials to repair digital nerves and mixed sensory-motor nerves were encouraging regarding sensory recovery but motor recovery was poor, probably because of delayed repair. We present the functional outcome of repair of motor nerves using denatured muscle graft and compare the results with those using standard nerve graft techniques.

Pain syndromes after missile-caused peripheral nerve lesions: part 2--treatment.

Objective: To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome.

Methods: The study included 326 patients with clinically significant pain syndromes, including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Treatment modalities included drug therapy, nerve surgery, sympatholysis, and dorsal root entry zone operation.

Pain syndromes after missile-caused peripheral nerve lesions: part 1--clinical characteristics.

Objective: To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries.

Methods: The prospective study included 326 patients with clinically significant pain syndromes including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Diagnostic procedures were analyzed, factors influencing the pain intensity were identified, and the patients' characteristics, pain characteristics, and other clinical symptoms and signs were compared between different types of pain syndromes.

Difference in recovery potential of peripheral nerves after graft repairs.

Objective: To our knowledge, few studies have been published regarding differences in nerve recovery potentials. In this study, sensory and motor recovery potentials were compared between different nerves.

Methods: A prospective study of a homogenous group of 393 graft repairs of the median, ulnar, radial, tibial, peroneal, femoral, and musculocutaneous nerves, with the scoring of motor and sensory recoveries.

Missile-caused complete lesions of the peroneal nerve and peroneal division of the sciatic nerve: results of 157 repairs.

Objective: There are few large-volume studies of the repair of complete missile-caused peroneal nerve and peroneal division lesions. In this prospective study, the outcomes of such repairs are studied and the factors influencing the outcomes are analyzed.

Methods: During a 3-year period, 157 patients with complete missile-caused lesions of the peroneal nerve or peroneal division were treated surgically in the Belgrade Military Medical Academy: 37 patients with high-level (above the middle of the thigh), 90 patients with intermediate-level (above the popliteal crease), and 30 patients with low-level repairs.

Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs.

Object: Very few extensive studies regarding the repair of missile-induced tibial nerve or tibial division complete lesions have been published to date. In this prospective study, the outcomes of such repairs as well as factors influencing them are presented.

Methods: Between 1991 and 1994, 119 patients with missile-induced complete lesions of the tibial nerve or tibial division were treated in the neurosurgical department of the Military Medical Academy, Belgrade.

Missile-caused median nerve injuries: results of 81 repairs.

Background: Missile-caused median nerve injuries have rarely been reported in current literature. We present repair outcome for all median nerve injuries in which the median nerve was severed either by missile injury or secondarily in the subsequent resection of a neuroma in continuity.

Methods: Prospective study included 81 casualties with proximal, intermediate, or distal complete median nerve lesions, repaired by nerve graft or direct suture.

Missile-caused ulnar nerve injuries: outcomes of 128 repairs.

Objective: This prospective study presents repair results after missile-caused ulnar nerve ruptures as well as factors influencing the outcomes.

Methods: Between 1991 and 1994, 128 casualties with missile-caused complete ulnar nerve injury were managed surgically in the Neurosurgical Department of the Belgrade Military Medical Academy. At least 4 years after surgery, we scored sensorimotor recovery, neurophysiological recovery, and patient judgment of the outcome.

Missile severances of the radial nerve. Results of 131 repairs.

Background: Reports on missile-caused radial nerve injuries are relatively rare in current literature. We present the outcome after repair of such injuries as well as the factors influencing the result of treatment.

Methods: Prospective study included 131 complete missile-caused radial nerve severances repaired with nerve graft or direct suture.

[Outcome of surgical treatment of malignant astrocytoma of the brain].

Background: The aim of this study was to analyze the outcome after the surgical treatment of patients with malignant brain astrocytomas, as well as the factors influencing the outcome. Retrospective study was performed on 145 operated patients (102 with glioblastoma multiforme, and 43 with anaplastic astrocytomas).

Methods: Clinical state was graded according to the Yasargil scale (grades I-IV) and the Karnofski score, and the outcome was defined either as good (better or unchanged clinical state) or as poor (deteriorated state or death).

Factors influencing the outcome after the operative treatment of cerebral aneurysms of anterior circulation.

Background: The influence of various factors on the outcome after the operative occlusion of the cerebral aneurysm was to be defined through the retrospective study on 111 surgically treated patients with aneurysm of anterior cerebral circulation.

Methods: Preoperative clinical condition was graded from 0 to V, according to Hunt & Hess. Postoperative outcome, defined as good or bad according to modified Glasgow Outcome Scale, was correlated in homogenous experimental groups with the following factors: gender, age, aneurysmal size, preoperative interval, nimodipine therapy, experience of surgical team and existence of chronic vascular diseases.

[Complications and mortality in surgery of cerebral aneurysms].

Aim: To establish the risk factors for complications and fatal outcome after the operative occlusion of cerebral aneurysms.

Methods: Retrospective study on 91 (lethality rate) and on 72 operated patients (complications). For survived and dead patients, as well as for patients with and without complications, following parameters were compared: gender, age, clinical condition, preoperative interval, use of temporary clips, vasospasm, outcome, as well as localization, size and intraoperative rupture of the aneurysm.

[Multiple cerebral aneurysms].

Background: To define risk factors for the multiplicity of cerebral aneurysms, as well as clinical and therapeutical characteristics of patients with single aneurysms (SA) and multiple aneurysms (MA).

Methods: Retrospective study on 95 patients with SA and 22 patients with MA. For patients with SA and MA the following parameters were compared: gender, age, clinical state, aneurysmal localization and size, incidence of rebleeding and vasospasm, manner and outcome of treatment, preoperative interval, intraoperative rupture and postoperative complications.

[Treatment of aneurysms in the anterior cerebral circulation].

Objectives: To analyze the outcome of either surgical or conservative treatment of patients with aneurysms on cerebral arteries.

Design: Retrospective study on 114 patients (89 operated and 25 not operated).

Methods: Clinical state was graded from 0 to V, according to Hunt & Hess (HHG), and the treatment outcome was defined as favorable or poor, according to the modified Glasgow Outcome Score.

[Diagnosis of subarachnoid hemorrhage].

Objectives And Methods: A total of 115 patients with subarachnoid hemorrhage were retrospectively analyzed with the aim to evaluate the timing and reliability of the applied diagnostic procedures. In the group of 63 patients the reliability of CT as the diagnostic procedure was investigated, and CT scan was correlated with the clinical status of the respective patient. In the group of 79 patients with operatively treated cerebral aneurysm the angiographic and intraoperative findings were mutually compared and discrepancies were analyzed.

[Risk factors for the onset of vasospasm and rebleeding after spontaneous subarachnoid hemorrhage].

Retrospective study comprised 120 patients with spontaneous subarachnoid hemorrhage (SAH) and risk factors for vasospasm and rebleeding were analyzed. Rebleeding and vasospasm had the same incidence (26.7%).

[Primary neurosurgical treatment of craniocerebral war injuries].

From September 1991 to December 1992, 41 patients with nonpenetrating and 84 patients with penetrating craniocerebral injuries were neurosurgically treated at the Military Medical Academy. The severity of injuries was estimated according to GCS and the outcome according to GOS. In 17 out of 27 patients with moderate nonpenetrating CCI, the outcome was favorable, and 5 patients out of 7 with severe CCI died (p < 0.

Factors influencing the outcome of nerve repair.

The dependence of the nerve repair outcome on the following 7 factors was analyzed: regenerative potential of the interrupted nerve, local vascular and scar state, level of nerve lesion, applied surgical technique, length of nerve defect, preoperative interval and patient's age. Prospective study included 490 ruptures of peripheral nerves, operated in two years period and the final outcome was established 24-30 months after reparation. The influence of the each of mentioned factors on the treatment outcome was tested in experimental groups, in which total homogenization existed, according to all other factors which could cause the differences in the repair outcome.